First Author: V.Lemos PORTUGAL
Co Author(s): A. Cabugueira M. Noronha R. Flores P. Ferreira J. Branco 0 0 0 0 0 0 0 0 0
Back to previous
To report a case of tuberculosis presenting as retinal vasculitis.
Retinal vasculitis occur as an idiopathic condition or associated with autoimmune or infectious diseases such tuberculosis (TB). Intraocular TB has an incidence of 2 % and can have different clinical manifestations including retinal vasculitis. Diagnosis may be difficult and presumptive being based on clinical findings and evidence of systemic TB.
Caucasian 15 years-old boy with sudden painless visual loss in his left eye (LE). Best-corrected visual acuity (BCVA) was 10/10 in the right eye (RE) and 4/10 in LE. Fundoscopic examination showed signs of peripheral vasculitis in RE and macular edema, superior and inferior temporal hemorrhages and prominent sheathing of retinal vessels in LE.
Angiography revealed temporal venous occlusion, macular edema and mid-periphery ischemia in LE. Investigation included Mantoux test 15 mm, IGRA QuantiFERON negative and IGRA T-SPOT positive. After treatment with corticosteroids and antituberculosis, there was progressive clinical improvement. Photocoagulation of ischemic areas was performed. His final BCVA was 20/20 bilaterally.
Tubercular retinal vasculitis is characterized by vitritis, retinal hemorrhages, neovascularization and neuroretinitis. Fluorescein angiography contributes to the diagnosis and tuberculin test for the pathogenesis, sometimes intraocular fluids samples are needed. Close follow-up and preemptive treatment (antituberculosis, corticosteroids and photocoagulation) is imperative to manage possible disease complications and iatrogenic effects as ethambutol optic neuritis.